I have been an unapologetic critic of Obamacare, castigating both the politically motivated choices Congress made, and the accounting tricks and misrepresentations they used to get it passed. The crucial deliberations about funding, coverage, cost savings, medicare. medicaid, specialists, hospitals, nursing home care and rationing were either absent or criminally misleading. Pelosi and Reid pandered to their base and passed the bill over the objections of the majority of Americans. This voter unhappiness is reflected in the recent referendum in Missouri where voters rejected Obamacare 71-29, a resounding defeat.

Yet in spite of my unrelenting attacks on Obamacare, I am not rejoicing at the Missouri vote. Ironically, I support many of the underlying goals of reform, and take issue with many of the politically motivated opponents of Obamacare. The most vociferous denunciations of the Pelosi bill emanate from those promulgating the economic principles of free enterprise, market forces, and small government. Although intellectually appealing, such arguments are also disingenuous. These Obamacare critics, like its advocates, refuse to confront the hard realities of actually caring for the sick. To resurrect an analogy I used previously, the American health care system is a house of cards, several miles high, having both market and government components. "Leaving it to the marketplace" is just as duplicitous as the accounting tricks and deceptions so rife in Obamacare. Medical care, by definition, cannot be a free market. Doctors have a monopoly on the information, and once a choice is made about care, it frequently cannot be changed.

Furthermore, costs are so high that virtually no one can pay for care without insurance. For these reasons, health insurance is often cited as the prime example of "market failure", which I will discuss later. Although I believe individual behavior is guided by market principles, and can be used for properly aligning health care incentives, if we wish to provide basic medical care to every member of our society, government will have to be involved. Such a goal should be a prerequisite for a civilized society. Both sides need to drop their cynical, partisan, deceptive rhetoric and start talking about what level of medical care we guarantee to people, what we wish to spend, and how we will pay for it. Who will ration care, and how will we tell people "no more"? If people want more care, how can they pay for their own, additional insurance? How will government pay doctors, hospitals, and drug companies, how much and who decides? Should we keep or break the accidental linkage of work with health insurance? Such questions are inherently difficult as they involve the life and health of every one of us and the people we care about. These are society's choices, we elect our representatives to both frame the discussion and make the decisions. We need to hold them accountable, and not allow the cowardly pandering that has characterized the debate up until now.